Management specificities for abdominal, pelvic and vascular penetrating trauma

Hornez, E.; Béranger, F.; Monchal, T.; Baudouin, Y.; Boddaert, Guillaume; Lesquen, Henri de; Bourgouin, Stéphane; Goudard, Yvain; Malgras, Brice; Pauleau, Ghislain; Reslinger, V.; Mocellin, N.; Natale, Claudia De; Meyrat, L.; Avaro, J.-P.; Balandraud, Paul; Gaujoux, Sébastien; Bonnet, Stéphane

doi:10.1016/j.jviscsurg.2017.10.009

Cited by 5 publications

(10 citation statements)

References 26 publications

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“…Correspondence: Email: ziaur.rehman@aku.edu vena cava proximally and distally is an important part of haemorrhage control. 6 This can be helped by spongesticks. Even with adequate compression, haemorrhage can be significant from renal and lumbar venous bleeding.…”

Section: Inferior Vena Cava Injuries -A Clinical Reviewmentioning

confidence: 99%

Inferior vena cava injuries - a clinical review

Rehman

2019

J Pak Med Assoc

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Inferior vena caval (IVC) injuries are uncommon and challenging to treat. Less than 5% of patients with penetrating abdominal trauma and less than 0.5% of patients with blunt abdominal trauma have this injury. Patient can present with intraperitoneal haemorrhage or with a contained retroperitoneal haematoma. Mostly it is associated with other abdominal structures injuries. Most commonly injured segment is infrarenal IVC. Operative strategy is different for each segment of injured vein. Infrahepatic injuries are exposed by medial visceral rotation. Retrohepatic and suprahepatic injuries need infrequent exposures. Mortality remains high and range between 31-51% for the patient brought alive to the operative room. Glasgow coma scale, level of injury, haemodynamic status at presentation and free blood in the peritoneal cavity are some of the predictive factors for mortality in these patients.

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Section: Inferior Vena Cava Injuries -A Clinical Reviewmentioning

confidence: 99%

Inferior vena cava injuries - a clinical review

Rehman

2019

J Pak Med Assoc

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“…While this article focuses on reviewing CT findings in patients who have undergone DCS for severe abdominopelvic trauma, similar temporizing procedures can be applied for thoracic and neck exploration (8,9,13,14). Patients who have an anticipated surgical time of 60-90 minutes or vary according to age and geographic location.…”

Section: Dcs and Resuscitationmentioning

confidence: 99%

“…In a separate retrospective study (23), among a cohort of 73 patients who underwent CT within 24 hours of emergency thoracotomy or laparotomy for penetrating trauma, 38 patients were identified, with a total of 43 injuries not mentioned in the surgical report, most commonly orthopedic or genitourinary injuries. Seven patients required more or who develop progressive hypothermia and/or coagulopathy may benefit from changing the surgical approach from definitive repair to DCS (5,8,12,14). DCS for abdominal trauma includes a midline laparotomy with suction of the hemoperitoneum and packing with surgical pads.…”

Section: Imaging After Dcsmentioning

confidence: 99%

“…DCS for abdominal trauma includes a midline laparotomy with suction of the hemoperitoneum and packing with surgical pads. The bowel is examined from the ligament of Treitz to the rectum, with removal of or temporary exclusion of injured or devitalized segments and deferral of reconstitution of bowel continuity (6,11,14). Contamination of the abdominal cavity or retroperitoneum from bowel, biliary, pancreatic, or urinary leaks typically additional surgery for those injuries, and four other patients underwent arterial procedures performed by interventional radiologists.…”

Section: Imaging After Dcsmentioning

confidence: 99%

“…Mesh or silastic material should be avoided because of the increased risk of an unplanned hernia and development of a fistula, which are thought to arise from an inflammatory response to the foreign material. The goal is fascial closure without tension or a planned hernia within 8 days or less of initial surgery to avoid substantial formation of granulation tissue (14,36,38,39).…”

Section: Abdominal Wall Closure Devicesmentioning

confidence: 99%

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Multidetector CT Findings in the Abdomen and Pelvis after Damage Control Surgery for Acute Traumatic Injuries

et al. 2019

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After experiencing blunt or penetrating trauma, patients in unstable condition who are more likely to die of uncorrected shock than of incomplete injury repairs undergo emergency limited exploratory laparotomy, which is also known as damage control surgery (DCS). This surgery is part of a series of resuscitation steps, with the goal of stabilizing the patient's condition, with rapid surgical control of hemorrhage followed by supportive measures in the intensive care unit before definitive repair of injuries. These patients often are imaged with multidetector CT within 24-48 hours of the initial surgery. Knowledge of this treatment plan is critical to CT interpretation, because there are anatomic derangements and foreign bodies that would not be present in patients undergoing surgery for other reasons. Patients may have injuries beyond the surgical field that are only identified at imaging, which can alter the care plan. Abnormalities related to the resuscitation period such as the CT hypoperfusion complex and ongoing hemorrhage can be recognized at CT. Familiarity with these imaging and clinical findings is important, because they can be seen not only in trauma patients after DCS but also in other patients in the critical care setting. The interpretation of imaging studies can be helped by an understanding of the diagnostic challenges of grading organ injuries with surgical materials in place and the awareness of potential artifacts on images in these patients.

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